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RET 2934 > Chapter 7 > Flashcards

Chapter 7 Flashcards

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1
Q

List 2 indications for IPPB?

A
  1. Need for delivery of medications to
    patients who cannot take a deep breath (<
    10 ml/kg IBW)
  2. Atelectasis especially in sedated post-op
    patients and patients recovering from
    abdominal or chest surgery who are more
    reluctant to breath deeply or cannot take
    breaths on their own
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2
Q

List 5 hazards of IPPB?

A

Excessive ventilation
Gastric distention
Decreased cardiac output
Increased ICP
Pneumothorax

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3
Q

List 2 contraindications for IPPB?

A

Untreated pneumothorax
Pulmonary hemorrhage

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4
Q

The pulse rate must not exceed how many
beats/min before treatment must be terminated?

A

20 beats/min

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5
Q

What does an inc. Raw have on delivered tidal
volume on a pressure limited IPPB machine?

A

Dec. VT

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6
Q

What affect does an inc. CL have on the
delivered VT on IPPB machine?

A

Inc. Vt

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7
Q

How does lung compliance affect Ti?

A

Decreases Ti

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8
Q

How should IPPB be modified for a patient
w/closed head injury?

A

Place the patient in Fowlers position to avoid
increased ICP. High pressures should be avoided
and short inspiratory pressures should be used
by increasing inspiratory flow rate.

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9
Q

Incentive spirometry is indicated if a patient can
obtain a vital capacity of what level?

A

More than 10 ml/kg of body weight.

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10
Q

What is another word used for incentive
spirometry?

A

Sustained maximal inspiratory therapy

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11
Q

List 3 requirements necessary for incentive
spirometry?

A

Cooperative patient
Motivated patients
Patients respiratory rate should be less
than 25 breaths/min

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12
Q

What is IPPB?

A

A short-term 10-15 min breathing treatment in
which pressures above atmospheric pressure are
delivered to the patients lungs via a pressure
limited ventilator.

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13
Q

What are the 4 factors for effective IPPB?

A
  1. An RRT who has been well trained and has
    the knowledge of the equipment,
    medications used, reasons for therapy,
    side effects and goals of therapy.
  2. A relaxed informed, and cooperative
    patient
  3. A pressure limited IPPB machine with a
    means of measuring Vt
  4. Proper instruction of the patient on
    breathing patterns
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14
Q

If there is decreased venous return and left
ventricular pressure during therapy what might
the patient experience?

A

Tachycardia and a decrease in systemic blood
pressure

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15
Q

What is normal ICP?

A

< 10 mmHg

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16
Q

Pneumothorax is most common in what
patients?

A

COPD patients with bollous disease or bleb
formation.

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17
Q

Patients who complain of sudden chest pain,
SOB, other breathing difficulties, or tachycardia
during IPPB must be suspected of what?

A

Pneumothrorax

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18
Q

If pneumothorax is suspected what should
happen?

A

Treatment should be stopped immediately.

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19
Q

What is gastric distention?

Study These Flashcards
A

Swallowing air during the treatment

20
Q

Gastric distention may cause the patient to
complain of what after?

Study These Flashcards
A

Nausea during or after treatment

21
Q

IPPB is safe for patients with a pneumothorax
that have a in place?

22
Q

If IPPB is administered in a pulmonary
hemorrhage air may enter the blood vessel
resulting in what?

23
Q

What should you review the patients chart for?

Study These Flashcards
A
  1. Last treatment given
  2. Latest chest film interpretation
  3. Latest ABG results
  4. Identify indications, potential hazards, and
    contraindications for treatment
24
Q

How much sensitivity does the patient need to
draw?

Study These Flashcards
A

no more than -2 cm H2O

25
Increased airway resistance results in what?
Decreased Vt Decreased Ti
26
Decreased airway resistance results in what?
Increased Vt Increased Ti
27
Increased lung compliance results in what?
Increased Vt Increased Ti
28
Decreased lung compliance results in what?
Decreased Vt Decreased Ti
29
Increased inspiratory pressure results in what?
Increased Vt
30
Decreased inspiratory pressure results in what?
Decreased Vt
31
Increased flow results in what?
Decreased Vt
32
Decreased flow results in what?
Increased Vt Increased Ti
33
WHAT DO YOU DO IF THE PATIENT IS HAVING DIFFICULTY CYCLING IPPB INTO THE INSPIRATORY PHASE?
Adjust sensitivty so that patient is generating a pressure of -0.5 to - 2cm H2O Make sure the machine is plugged into the wall gas outlet Ensure that the machine tubing connections are all tight Ensure that the patient has lips sealed tightly around the mouthpiece or mask to avoid leaks
34
WHAT DO YOU DO IF THE PATIENT COMPLAINS OF DIZZINESS AND TINGLING IN THE EXTREMITIES DURING THE TREATMENT BUT HAS NO APPRECIABLE INCREASE?
Instruct the patient to breathe slower and to pause longer between breaths
35
WHAT TO DO IF THE PATIENTS HEART RATE INCREASES MORE THAN 20 BEATS PER/MIN DURING TREATMENT?
Stop the treatment immediately and notify the physician. This is most likely the result of the nebulized bronchodilating agent stimulating the heart
36
WHAT TO DO IF THE PATIENT CANNOT CYCLE THE IPPB MACHINE OFF?
Tighten all tubing connections Ensure that there are no leaks around the mouthpiece, mask, or nose. Nose clips should be used if air is leaking out Ensure that the ETT or trach cuff is inflated and adequately to prevent leaks Check the circuits of the expiratory valve function
37
WHAT TO DO IF THE PATIENT INHALES BUT THERE IS NO NEBULIZATION OF THE MEDICATION?
Ensure that the capillary tube of the neb is connected Ensure that the neb drive line is connected
38
What do we do if during inspiration the needle stays in the negative area for the first half of the breath and then rises to the positive area in the last half?
Increase the machine flow rate
39
What do we do if the IPPB machine repeatedly cycles on shortly after the patient has begun the expiratory phase.
Decrease machine sensitivity Make sure control is off
40
Flow meter for EzPAP is set to what?
5-10 lpm
41
EzPAP is indicated for what patients?
Atelectasis
42
What is the VC for EzPAP?
> 10 ml of IBW
43
What are the indications for I.S.?
Presence of atelectasis Patients prone to atelectasis such as postoperative patient following upper abdominal or thoracic surgery Presence of restrictive lung condition quadriplegia or impaired diaphragm
44
What are some complications of I.S.?
Hyperventilation: have patient pause longer between deep breaths Fatigue Ineffective if not performed properly I.S. is inappropriate if used as the only treatment for atelectasis or consolidation (Most effective when combined with ambulation). Discomfort secondary to inadequate pain control
45
What are the requirements for effective I.S.?
1. Cooperative patient. 2. Motivated patient. 3. Patient's respiratory rate should be less than 25 breaths/min.

RET 2934 (13 decks)

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